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Innovations in Chemotherapy Preparation Safety: Use of Telepharmacy and Barcode Technology in the IV Admixture Area

Brian O’Neal, M.S., Pharm.D., John Worden, M.S., Pharm.D., Rick Couldry, M.S., R.Ph.


The University of Kansas Hospital, Kansas City, Kansas

Many academic medical center pharmacies—including the inpatient pharmacy at the University of Kansas Hospital—use the syringe pullback method for checking chemotherapy preparations. This method requires that a pharmacist check the plunger of an empty syringe to determine the volume of medication added to an admixture. The risk of error associated with this checking method is high, given that a pharmacist typically does not check the volume of the syringe prior to injection into the  intravenous solution bag.  To reduce the risks associated with the syringe pullback method, pharmacy administrators at the University of Kansas Hospital instituted the use of telepharmacy hardware and software to take digital photographs of the chemotherapy preparation process. These photographs, taken at critical risk points in chemotherapy preparation, are able to be reviewed remotely by pharmacists. Additional goals of the project were to improve the readability of chemotherapy-vial labels and to reduce the risk of selecting the wrong chemotherapeutic medication through the use of barcode technology.

Working with an automation vendor (ScriptPro; Mission, Kansas), pharmacy administrators placed a telepharmacy inspection camera designed to take digital pictures at various stages of the chemotherapy preparation process in a biological safety cabinet in the clean room.  First, a technician scans the barcode on the vial. He or she then takes photos of the work label, the vials and fluids to be used, and, lastly, the syringe (before injection into the bag). A pharmacist views these photos from a “check station” in the ante room when verifying the finished product.

After one month, this process demonstrated safety improvements in four main areas:

  • Verifying chemotherapy products with barcode technology helped to ensure that the correct drug was selected.
  • Inspecting photographs of the syringe before it was injected into the bag of fluid increased the likelihood of detecting technicians’ errors.
  • Digitally enlarging the small font on chemotherapy vials helped pharmacists to accurately check the finished product.
  • Disposing contaminated syringes and vials in the chemo preparation area reduced the risk of contaminating other areas of the clean room.

This use of telepharmacy and barcode technology resulted in a pharmacist’s intervention in 1.1% of prepared doses (4 out of 363) during the data collection period (July 1 through July 31, 2007). An intervention was defined as a pharmacist’s request to increase volume, decrease volume, or to remake the product.   

The improvements in safety and accountability led us to discontinue use of the syringe pullback method for checking chemotherapy. Without interrupting workflow, a pharmacist can now observe the riskiest steps of chemotherapy preparation thus increasing the odds of detecting errors. Our compounding error rate is no longer unknown and unidentifiable. By documenting and reviewing more of the steps in the chemotherapy preparation process with telepharmacy and barcode technology, we have significantly increased our chances of catching errors before they leave the pharmacy.

View a pdf of the poster from the Midyear Meeting (508KB).